Introduction Checklist for Outpatient Therapy Discharges Checklist for Outpatient Therapy Appeals Quick Screen: Medicare Coverage for Outpatient Therapy Outpatient Therapy Appeal Details Additional Information 1. Introduction Dear … [Read more...] about Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials
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CMA Community News – January 2014
Editor's Note: We received some feedback that our text was a bit small, so we are bumping it up for this edition. Please let us know what you think. A Message from the Executive Director News You Can Use Legislative Watch CMA In the … [Read more...] about CMA Community News – January 2014
February 2014 – Improvement Standard Update: Re-Review of Previously Denied Claims Pursuant to Jimmo and Other Issues
1. PRESENTATION: RE-REVIEW OF PREVIOUSLY DENIED CLAIMS PURSUANT TO THE JIMMO SETTLEMENT In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. … [Read more...] about February 2014 – Improvement Standard Update: Re-Review of Previously Denied Claims Pursuant to Jimmo and Other Issues
Bourgoin v. Sebelius
No. 13-cv-55-JAW (D.Me.), filed February 20, 2013 Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will … [Read more...] about Bourgoin v. Sebelius
Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed
If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years. Please read carefully. In addition to revising Medicare manual … [Read more...] about Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed
One-Year Anniversary of Medicare Improvement Standard Settlement Brings Victories, and Ongoing Struggle, for Beneficiaries
January 24, 2014 - Today marks the one-year anniversary of the landmark Jimmo v. Sebelius settlement. The Jimmo case was brought in 2011 by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of a nationwide class of Medicare … [Read more...] about One-Year Anniversary of Medicare Improvement Standard Settlement Brings Victories, and Ongoing Struggle, for Beneficiaries
Medicare Therapy Caps: A Call for Repeal
Medicare-covered outpatient physical, speech and occupational therapy services are subject to an annual dollar-amount payment cap. As a result, many Medicare beneficiaries have their therapy terminate prematurely when they reach the cap. … [Read more...] about Medicare Therapy Caps: A Call for Repeal
Medicare Policy Manuals Revised as Required by Jimmo Settlement
As of December 6, 2013, Centers for Medicare & Medicaid Services (CMS) Policy manuals have been updated to reflect the settlement in Jimmo vs. Sebelius, No.11-cv-17 (D.VT, January 24, 2013). The manuals now make it clear that improvement is … [Read more...] about Medicare Policy Manuals Revised as Required by Jimmo Settlement
Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?
Overview The current Medicare physician payment formula, known as the "Sustainable Growth Rate" (SGR), was designed to control the growth in aggregate Medicare expenditures for physicians' services.[1] If … [Read more...] about Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?
December 2013 – Improvement Standard Update: CMS Issues Manual Provisions Pursuant to Jimmo, and Other Issues
1. PRESENTATION: CMS MANUAL PROVISIONS ISSUED PURSUANT TO THE JIMMO SETTLEMENT The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement. … [Read more...] about December 2013 – Improvement Standard Update: CMS Issues Manual Provisions Pursuant to Jimmo, and Other Issues